Abstract
BackgroundL-thyroxine (L-T4) malabsorption is a potential concern in patients with autoimmune atrophic gastritis.MethodsWe evaluated five patients with autoimmune gastritis, who showed high serum thyrotropin (TSH) levels (in the hypothyroid range) while in therapy with L-T4 in tablet. All patients were switched to receive an oral L-T4 liquid formulation maintaining the same dosage.ResultsIn all patients who received L-T4 in tablet form after switching to an oral liquid formulation with the same L-T4 dosage, TSH circulating levels were normalized. In four patients who were switched back again to receive L-T4 in tablets, maintaining the dosage, TSH levels worsened again reaching levels in the hypothyroid range.ConclusionsThe fact that the change from tablets to liquid oral formulation normalised serum TSH levels, and that switching back to tablets caused thyrotropin levels to worsen, leads us to believe that absorption of L-T4 is greater with oral liquid formulations in these patients. These results suggest that the L-T4 oral liquid formulation could circumvent the pH alteration resulting from atrophic gastritis.
Highlights
L-thyroxine (L-T4) malabsorption is a potential concern in patients with autoimmune atrophic gastritis
For the presence of persistent and severe dyspsepsia, she underwent a gastroenterological examination that showed the presence of high levels of gastrin (435 pg/mL), and of increased levels of serum parietal cells antibodies, in presence of atrophic gastritis, while the search for H. pylori or H. pylori antibodies was negative
To confirm the presumed relationship between oral formulation and TSH normalisation, L-T4 was re-administered at the same dosage in tablet form
Summary
L-thyroxine (L-T4) malabsorption is a potential concern in patients with autoimmune atrophic gastritis. Intestinal absorption of thyroxine is influenced by several factors, including the age of the patient, adherence to therapy, dietary habits, absorption kinetics, malabsorption, and interference of other drugs. Centanni et al showed that the daily requirement of thyroxine was higher (by 22 to 34 %) in patients with H. pylori-related gastritis, atrophic gastritis, or both conditions than in the reference group, in patients with multinodular goiter. These results strongly suggest that normal gastric acid secretion is necessary for the effective absorption of oral thyroxine [5, 6]. It has been shown that L-T4 requirement in patients with autoimmune hypothyroidism and parietal cell antibodies is increased [8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
